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Friday, August 11, 2017

It was the stethoscope in the ER, my dear Watson.

If you ever read or watched the Sherlock Holmes books, movies
or the TV series you will recall the line “Elementary, my dear Watson”. It was the explanation that Sherlock Holmes
gave to his assistant, Dr. Watson, when explaining deductions he had made. Science, like solving murders, is all about
deduction and solving mysteries and puzzles.

The same can certainly be said with infection prevention and
trying to find out who or what are transmitting infections and how. In recent years, there has been a huge push
on improving hand hygiene rates. There
has also been a focus on improving cleaning and disinfection processes,
particularly when it comes in environmental surfaces. Studies have looked at different types of
disinfectant actives, different cleaning processes, changing frequency of
disinfection, increasing staff (or decreasing staff), and implementing
verification methods to ensure that cleaning and disinfection has in fact
occurred. Several studies have shown
that changing products, processes and including a validation program could in
fact improve cleaning and disinfection showing a direct link to reducing
HAIs.

Regardless of the implementation of hand hygiene programs or
improving environmental surface disinfection, HAIs were not eliminated. Improved hand hygiene and enhanced cleaning
certainly showed a reduction in HAIs, but HAIs still occurred. Several years ago after conducting a cleaning
audit at a facility that was in the midst of an outbreak one of the
observations I made was that I never saw any cleaning and disinfection of patient
care equipment by nursing staff.

Don’t jump to conclusions.
I’m not saying that nurses are to blame for outbreaks, but the thought
came back in flash after reading a study that hoped to improve both hand hygiene and stethoscope hygiene. The
researchers’ intervention sought to educate staff regarding the importance of
stethoscope hygiene. Expectations were set that stethoscopes needed to be
disinfected between each patient encounter due to the fact that they are
repeatedly used throughout the day and can become contaminated after contact
with patients. This repeated use
throughout the day and between multiple patients make stethoscopes a key fomite
that can transmit pathogens from patient to patient. Unfortunately for the researchers (and maybe
the patients) of the 128 initial observations disinfection of the stethoscopes
never occurred. Post-intervention, an
additional 41 observations found that even with an education intervention to
discuss the importance of disinfection of the stethoscopes, no stethoscope
hygiene was performed.

I wonder just how wide spread the lack of stethoscope
hygiene is? I know the next time I’m at my doctor’s I’m going to ask when the
last time she disinfected her stethoscope was and may just offer to clean it
for her myself!